The spine journal : official journal of the North American Spine Society
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Walking capacity is a primary outcome indicator for individuals with lumbar spinal stenosis (LSS). Therefore, there is a demand for psychometrically sound measures of walking that are responsive to change. ⋯ The PF Scale, ODI, and walking capacity change score are able to detect changes in walking capacity in people with LSS. The individual walking capacity item from the ODI appears to be the most valid and responsive to changes in measured walking and may be a reasonable alternative for measuring walking when an objective test such as the SPWT is not feasible.
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Few studies have evaluated the extent of biomechanical destabilization of thoracic decompression on the upper and lower thoracic spine. The present study evaluates lower thoracic spinal stability after laminectomy, unilateral facetectomy, and unilateral costotransversectomy in thoracic spines with intact sternocostovertebral articulations. ⋯ The lower thoracic spine was not destabilized by sequential unilateral decompression procedures. Addition of dorsal fixation increased segment rigidity at intrinsic levels and also reduced overall ROM of the lower thoracic spine to a greater extent than did fusing the upper thoracic spine (level of the true ribs). Despite the lack of true ribs, the lower thoracic spine was not significantly different compared with the upper thoracic spine in FE and LB after decompression, although there were trends toward significance for greater AR after decompression. In certain patients, instrumentation may not be needed after unilateral decompression of the lower thoracic spine; further validation and additional clinical studies are warranted.
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Comparative Study
Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure.
Adolescent idiopathic scoliosis (AIS) patients treated before the 1990s have a 1% to 2% increased lifetime risk of developing breast and thyroid cancer as a result of ionizing radiation from plain radiographs. Although present plain radiographic techniques have been able to reduce some of the radiation exposure, modern treatment algorithms for scoliosis often include computed tomography (CT) and intraoperative fluoroscopy. The exact magnitude of exposure to ionizing radiation in adolescents during modern scoliosis treatment is therefore unclear. ⋯ Significant differences exist in the total radiation exposure in scoliosis patients with different treatment regimens, with operative patients receiving approximately 8 to 14 times more radiation than braced patients or those undergoing observation alone, respectively. Operative patients also receive more than twice the radiation per year than braced or observed patients. Almost 78% of the annual radiation exposure for operative patients occurs intraoperatively. Because children are notably more sensitive to the carcinogenic effects of ionizing radiation, judicious use of present imaging methods and a search for newer imaging methods with limited ionizing radiation should be undertaken.
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As the biomechanical foundation of the spine, the pelvis was found to display rotation in the transverse plane in adolescent idiopathic scoliosis (AIS). However, the possible factors influencing the pelvic axial rotation (PAR) and its mechanism in patients with AIS remain unclear. ⋯ The majority of AIS patients with right MT or left major TL/L curves were found to have PAR to the right, in the same direction as the thoracic curve. The lumbar flexibility and apex rotation significantly influenced the PAR direction and magnitude. Moreover, the pelvis might be involved in compensation for the MT deformity through its connection with the lumbar spine.